Introduction of the intubating laryngeal mask airway into paramedic practice

Background. It has been noted in many research papers that paramedic laryngoscopic tracheal intubation is an infrequently performed airway skill which is difficult to execute, this has been supported by many articles highlighting complications and poor success rates in the paramedic population. A major concern raised in the literature on paramedic tracheal intubation is the ability for this workforce to perform this skill and maintain their confidence and competence in this skill which is performed infrequently. Although laryngoscopic tracheal intubation is the method used almost exclusively by paramedics there are other devices available to achieve tracheal intubation. The implementation of a new device, an innovation, to perform tracheal intubation into a field such as paramedic practice where laryngoscopic tracheal intubation is held in such high regard is expected to face implementation challenges. Research Purpose. To examine the qualitative factors that affects the implementation of the Intubating Laryngeal Mask Airway into paramedic practice. Of particular interest are the educational practices which are affected by the introduction of an innovation. Research Design. A sequenced exploratory descriptive research design will use quantitative and qualitative data sources to answer the study's purpose. Data collection was achieved through a questionnaire which captured quantitative data and then a series of interviews which allowed deeper exploration of the findings. Findings. Paramedics had increased confidence when using the ILMA for tracheal intubation in their routine practice and achieved similar tracheal intubation success rates with the ILMA as the laryngoscope. The overall laryngoscopic tracheal intubation success rate was 91% (42/46) and the overall ILMA tracheal intubation success rate was 92% (48/52). A blended approach to AAM education improves confidence and competence. The paramedics' achieved an appropriate level of confidence and competence in ILMA tracheal intubation using manikins alone without the conventional in-theatre training component. Conclusion. Paramedic competence and confidence in AAM is influenced by a number of operational and educational factors and the introduction of the ILMA has been shown to be a suitable alternative to the laryngoscope for paramedic tracheal intubation. During the introduction of the ILMA a major change to the normal training methodology demonstrated that the traditional reliance on the hospital theatre to achieve progress along the learning curve toward competence and confidence in AAM practice can be improved. The successful introduction of an innovation into paramedic AAM practice requires a method which ensures the training process is efficient and the change to practice is effortless and sustained with maximum learning and the support of the workforce. The social change required for the introduction of an AAM innovation can be rapidly adopted after careful consideration of the social system and the characteristics unique to each innovation as described in Rogers Diffusion of Innovation (Rogers 2003) theory when developing the educational strategies.